Tag Archives: child

New Insights in Treatment Options in Pediatric Urinary Tract Infection

Carmen Duicu1, Iulia Armean2, Cornel Aldea3

1. University of Medicine, Pharmacy, Sciences and Technology of Târgu Mureș, Târgu Mureș, Romania
2. Pediatric Clinic 1, Emergency County Hospital Târgu Mureș, Romania
3. Pediatric Nephrology Department, Emergency Clinical Hospital for Children Cluj-Napoca, Romania

DOI: 10.2478/amma-2019-0002

Urinary tract infection (UTI) represents one of the most frequent infections with bacterial etiology during childhood. In infants and toddlers with fever without source UTI’ investigation should be carried out, since signs and symptoms are nonspecific. However, obtaining uncontaminated urine samples from these patients can be challenging and time consuming; all current collection methods (clean-catch, plastic collection bag, catheterization, etc) have disadvantages. Criteria for UTI definition are represented by the presence of significant number of a single uropathogen, this number being different depending on the collection method: at least 1000 colony-forming unit (CFU/ml) for catheter samples and at least 100.000 CFU/ml from midstream clean-catch samples or 50.000 CFU/ml and significant pyuria in a symptomatic or febrile child. Accurate diagnosis of UTI is essential to avoid any antibiotic overuse and expensive investigations. UTI caused by resistant bacterial strains has an increasing prevalence in children. In pediatric population, extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) represent the etiology of around 15% of UTIs. Because of limited therapeutic options the reintroduction of some old antimicrobial agents is necessary, therefore Nitrofurantoin and Fosfomycin, can represent alternatives for oral treatment and prophylaxis of UTIs in children or in case of resistance suspicion to other drug classes. It is important to recognize patients at risk, such as children with recurrent UTIs, kidney abnormalities, like vesicoureteral reflux and previous antibiotherapy, in order to recommend adequate empiric treatment, especially against resistant bacteria.

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The Role of Supportive Therapy in Pediatric Malignancies

Papp Zsuzsanna Erzsébet, Horváth Mária-Adrienne

Mures County Hospital- Pediatric Department, University of Medicine and Pharmacy Tirgu Mureș, Romania

DOI: 10.1515/amma-2016-0027

Childhood cancer is a major psycho-social and health problem. International study groups establish complex, efficient, and concrete Cytostatic Protocols for every cancer type. During chemotherapy patients become extremely vulnerable to infections, so it is necessary to complete the treatment with blood substitution, anti-infection medication, growth factors and other complementary products.
Materials and Methods: We studied the importance of the wide palette of adjuvant therapy near the intensive cytostatic treatment in the period of March 2014-November 2015 at the hemato-oncology department in Pediatric Clinic of Mures County Hospital.
Results: In this period we treated 20 children (9 female, 11 male) aged between 9 months-18 years. We had 15 cases of haemopathies (13 acute leukemia and two lymphomas), and five solid tumors. Packed red blood cells, platelets, and fresh frozen plasma were given in the aplastic period. A patient benefited, on average, a total of 70ml/kg packed red blood cells and 50 U platelets. For infection prophylaxis and treatment every child benefited associated infective medication.
Discussions: Packed red blood cells, platelets, and fresh frozen plasma were given to patients with a deficiency in the ability to produce normal blood cells which are temporarily worsened by chemotherapy. Antibiotic and antifungal medications are given to all febrile and neutropenic patients. We use wide spectrum antibiotics in association for preventing sepsis. Growth factors are stimulating the bone marrow to increase leukocyte number. Since introducing additional immunostimulant medication, we observed a significant decrease of infection in the aplastic period.
Conclusions: Oncology protocols use only 3-5 cytostatic drugs. Maintaining the patient’s life during the treatment, it is necessary to use a large spectrum of supportive medications.

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Nutritional Parameters in Children with Acute Leukemia

Chinceșan Mihaela, Baghiu Despina, Horvath Adrienne, Moldovan Diana

University of Medicine and Pharmacy of Tîrgu Mureș; Pediatric Clinic No. I, The Hematooncology Department

Background: Nutritional problems with children suffering from cancer varies from extreme malnutrition to complex nutritional problems due to both disease and treatment.
Aim: In this study we intend to assess the nutritional status of the children with acute leukemia and the malnutrition effect on the evolution of the disease.
Material and method: We have performed a retrospective study on a group of 53 children suffering from acute leukemia who were diagnosed and treated in The Pediatric Clinic No. I Targu-Mures, The Department of Hematooncology within the period of 2001–2009. The nutritional status is assessed through anthropometric, hemathological and biochemical parameters before the initiation of chemotherapy.
Results: The group of study included 32 males and 21 females, with an average age of 7.2 years at the beginning of the malignant disease; out of 53 patients, 46 were diagnosed with acute lymphoblastic leukemia and 7 with acute myeloblastic leukemia.
At the beginning of the malignant disease, 10 patients (18.9%) had the weight under percentage 5 . The height corresponding to the age was, at the beginning of the disease under percentage 5 with 6 patients (11.32%), showing a chronic state of
malnutrition. The hemoglobin is diminished to 88.67% of the patients. Sideremia was lowered to 3.77% of the patients and increased to 45.28%. 35.85% of the children had the serum proteins decreased, from which 28.30% had hypoalbuminemia.
We had in view a period of 6 months since the initation of chemotherapy the response to the treatment by: realising the remission, an occurance of relapse, infectious episodes, those of febrile neuthropenia and the rate of death. In our study we have found that along with the children with a proper nutritional status, the malnourished children show a higher amount of infectious episodes (9.66 versus 7,32 infectious episodes/child); the number of the febrile neutropenia episodes was higher (3.8 versus 2.01 episodes/child). The remission at 6 months was slightly inferior in malnourished children, yet, the rate of mortality has not been influenced.
Conclusions: 1. The prevalence of the assessed severe malnutrition based on the anthropometric indicators was 18.9% at the beginning of the malignant disease. 2. The children’s smaller height at the beginning of the tumoral disease is given by the chronic protein-caloric malnutrition,existing before the disease. 3. Among the malnourished patients, the frequency of the infectious episodes is higher and the remission at 6 months is inferior to those with a normal nutritional status, however the rate of death is not different.

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Issues on Malnutrition in Children with Cancer

Chinceșan Mihaela¹, Baghiu Despina¹, Mărginean Oana¹, Horváth Adrienne¹, Eșianu Andrea²

1 University of Medicine and Pharmacy of Tîrgu Mureș, Pediatric Clinic No 1
2 Emergency County Hospital Tîrgu Mureș, Pediatric Clinic No 1

Introduction: Malnutrition is present in a high percentage in children with cancer. It can be evaluated by anthropometric measurements and laboratory data.
Aims: 1. To determine the prevalence and severity of malnutrition at diagnosis in children with cancer. 2. To define the best modalities to assess nutritional status.
Material and methods: A prospective study was performed on 27 children hospitalized and diagnosed with various type of cancer in the Pediatric Clinic No.I Targu-Mures, between November 2009–January 2011. We evaluated anthropometric and biochemical parameters: weight, height, body mass index (BMI), middle-upper arm circumference (MUAC), triceps skin fold thickness (TSF), total protein, albumin, Insulin-like growth factor-1 (IGF-1). We divided patients into three categories depending on nutritional parameters: severely malnourished, risk of malnourished and adequately nourished. We correlated anthropometric parameters with biochemical parameters.
Results: Our group consisted of 20 males (74.04%) and 7 females (25.96%). Of the 27 children with cancer, 14 children were severely malnourished, 8 children were with risk of malnourished and only 5 children with normal nutritional status. At the onset of malignant disease, 16 patients (59.25%) had low serum protein values and 10 patients (37.03%) had low levels of serum albumin. IGF-1 was decreased in 18 children (66.66%). We found a good correlation, statistically significant between TSF and serum proteins (r = 0.41; p = 0.02), between TSF and IGF-1 (r = 0.44; p = 0.02), and between MUAC and IGF-1 (r = 0.39; p = 0.04).
Conclusions: 1. The prevalence of malnutrition in children with cancer is high. 2. Arm anthropometry in conjunction with serum protein and IGF-1 most accurately characterizing the nutritional status.

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Clinical and Epidemiological Considerations on Child Neglect in Pediatric Clinic No. I Tîrgu Mureș

Baghiu Maria Despina1, Borka-Balás Réka2, Mărginean Oana1, Man Lidia1, Moldovan Diana1, Pitea Ana-Maria1

1 University of Medicine and Pharmacy Tg. Mureş, Pediatry I Clinic
2 Clinical Center Pharmaquest, Tîrgu Mureș

Background: Ethic of the care is a necessary condition for a state under the rule of law. Neglect is failure by the caregiver to provide needed, age-appropriate care to a child. Article 89 of law 272/2004 on the protection and promotion of child rights clearly defines child neglect.
Objective: The purpose of the paper is to assess the number of cases of neglected children hospitalised in Pediatrics Clinic I Tîrgu Mureș, and to report and emphasize the ethical importance of this problem.
Material and method: It was a retrospective study based on observation sheets of children admitted in Pediatrics Clinic I Tîrgu Mureș, between 01 January 2001 – 31 December 2008. During this period 728 cases of child neglect were identified.
Results: The incidence of mistreated children was 6.13% (728 cases) with mean age of 4.85 years, from 11.859 admissions in the mentioned period. Increased number of childs nelegt was in rural areas (64.69%) between boys (52.60%).
We considered child neglect in the studied group: accidental poisoning 484 cases (66.48%), malnutrition (19.23%), scabies (8.38%), pediculosis (1.92%), prolonged hospitalization (2.06%), other causes (1.93%).
Conclusions: Mistreated children represented an important share of admissions (6.13%), raising many ethical issues concerning child rights violations. Although that in our country child neglect must be reported to social protection services as required by law, solved cases and prevention measures are sporadic.

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Nutritional Status Assesment in Overweight and Obese Children

Pitea Ana Maria, Baghiu Maria Despina, Mărginean Oana, Eșianu Andreea

Pediactrics Clinic 1, Faculty of Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Obesity represents the abnormal/excessive accumulation of fat in adipose tissue. Anthropometry takes a person’s body measurements, especially for use on a comparison or classification basis to establish his/her nutritional status. Nutritional condition also includes clinical examination and laboratory findings. Our aim was to assess the nutritional status in a group of obese children versus normal-weight children.
Material and methods: Our prospective study, conducted between October 1, 2010 and April 15, 2011, included a study group with 20 obese children and a control-group with 35 healthy children; we performed antropometric measurements, we calculated some anthropometric indices and performed laboratory tests, abdominal ultrasound and real-tyme elastography; statistical analysis involved Graph PadPrisma and Graph Pad InStat Demo programme; Student’s t test and correlation coefficient Pearson were used.
Results: Children weight and weight-for-age z-score significantly differed between the study-group and controls, at each age group, stature and height-for-age z-score was not significantly different. Medium upper-arm circumference (MUAC) had higher values than Body Mass Index, (BMI), while Tricipital Skin-fold (TSF) recorded the highest values, reflecting the fat deposits of obese children (in controls these indices were between -2SD and +2SD). The laboratory findings were generally within normal limits; total cholesterol values were higher in obese and triglycerides were incresed in a part of children in which they were determined. Liver elasticity was lower in obese than in the control-group.
Conclusion: Overweight alters the nutritional status, disturbs lipid metabolism and decreases the elasticity of the liver, highlighting the risks related to obesity and the importance of prevention and treatment of this disorder.

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Indication for Pediatric Heart Transplantation – Romanian Peculiarities

Sglimbea Anca1, Toma Roxana1, Suciu H1,2, Deac R2

1 Clinic of Cardiovascular Surgery, Tîrgu Mureș, Romania
2 University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: Heart transplantation is nowadays a well established and succesfull therapy in both pediatric and adult heart failure. There are several guidelines for adult transplantation, while pediatric transplantation benefits of the indications established in 2007 by the American Heart Association. These are based on western experience and infrastructure. In Romania, this therapy is being performed mainly in the last 5 years, with a small number of patients transplanted.
Methods: We have analyzed the way indication for transplantation has been established in our 5 patients and compared it to the recommendations from the generally accepted guidelines.
Results: There are significant differences regarding age at transplantation, underlying heart disease, as well as stage of heart failure and medical therapy before transplantation. Our patients are older, transplanted mainly for dilated cardiomyopathy, mainly in NYHA functional class IV, but not hospitalized or on intensive care.
Conclusion: There is an imperative need for establishing the number of necessary donor hearts at a national level, as well as starting a vigurouse campaign to increase organ donation in Romania.

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The Results of ARFI (Acoustic Radiation Force Impulse) Elastographic Assessment of Liver Aspect and NAFLD (Non-alcoholic Fatty Liver Disease) in Pediatric Obese Patients Compared to Normal-weight Children

Mărginean Oana, Brînzaniuc Klara, Mărginean C, Voidăzan S, Pitea Ana Maria

University of Medicine and Pharmacy, Tîrgu Mureș, Romania

Background: The incidence of obesity has dramatically increased in the last few years, and associated disorders such as non-alcoholic fatty liver disease (NAFLD) constitute a serious threat. The objective of our study was to assess the liver aspect of obese children and adolescents by real-time elastography, ARFI-technique, compared to the liver aspect of normal-weight children.
Methods: Eighty-six children, aged 3–18 years, admitted to the County Emergency Clinical Hospital of Tîrgu Mureș between 15 September 2010 and 15 April 2012, were recruited for the study. They were included in two groups: 39 overweight/obese children and 47 normal-weight healthy controls. We evaluated the liver-tissue elasticity by measuring the Shear Wave Velocity (SWV), globally and separately for segments 1 and 8 in order to detect possible differences beetween them, knowing that the caudate-lobe has it’s own vasculature; we also evaluated biochemical parameters (transaminases, etc). Correlations between SWV and laboratory tests were established using non-parametric Spearman correlation test.
Results: In healty children in the 1st segment SWV was 1.012±0.31 m/s, smaller than in the 8th segment, 1.342±0.32 m/s (p = 0.0316). For obese children, SWV was higher in the 8th segment 1.982±0.85 m/s compared to the 1st segment 1.325±0.27 m/s (p <0.0001). Globally in obese children, the SWV was 1.746±0.49 m/s, significantly higher than in healthy children, 1.080±0.27 m/s (p = 0.0023). Positive statistical correlations have been established between SWV and aspartate-aminotransferase in obese (r = 0.61, Pearson correlation p = 0.025), with no statistically significant differences for other laboratory findings.
Conclusion: Elastographic evaluation of liver alterations in obesity by ARFI-method shows higher SWV, which could be translated in fibrosis and necroinflammatory activity. According to our study, these alterations in liver tissue affect mainly the right lobe of the liver.

 

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Pulmonary Tuberculosis Wheezing in Early Childhood

Dumitra G1, Bobârnac Ana2, Dinescu Venera3, Bulucea D4

1 Family physician, University of Medicine and Pharmacy, Craiova, Romania
2 Department of Pneumology, University of Medicine and Pharmacy, Craiova, Romania
3 Department of Hygiene and Environmental Health, University of Medicine and Pharmacy, Craiova, Romania
4 University of Medicine and Pharmacy, Craiova, Romania

DOI: 10.2478/amma-2013-0035

Background: Primary pulmonary tuberculosis in children and infants can be suggested by the presence of a wheezing, often interpreted as acute bronchiolitis or asthma. The objective of this study is to assess the frequency and mechanism of wheezing in infants and toddlers with tuberculosis and to assess its value as an alarm symptom in children from areas where tuberculosis incidence is high.
Material and method: We carried out a retrospective study in the Pediatric Clinic of the ”Filantropia” Municipal Hospital Clinic of Craiova between 2007–2011. We studied 25 children and infants, who at hospitalization presented signs like: wheezing, cough and dyspnoea.
Results: There were 25 children and infants diagnosed with primary tuberculosis. Twenty-one cases (84%) came from rural areas and 56% (14 cases) occurred in infants. Out of the 25 cases, 22 (88%) presented wheezing, 18 (72%) were accompanied by dyspnoea and 16 patients (64%) presented cough. The majority of cases (16 out of 25, representing 64%) came from families in which a tuberculosis focus was identified during the epidemiological investigation.
Conclusions: The positive epidemiological research, together with other data provided by the clinical, laboratory analyses and the collaboration with other specialties determine the classification of wheezing as a symptom within tuberculosis.

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Evaluation of Anthropometric and Biochemical Status in Children with Nutritional Deficiency

Man Lidia1, Pitea Ana Maria1, Chinceșan Mihaela Ioana1, Man A2, Mărginean Oana1, Baghiu Maria Despina1

1 Pediatric Clinic I, University of Medicine and Pharmacy, Tîrgu Mureș, Romania
2 Department of Microbiology, Laboratory Medicine, University of Medicine and Pharmacy, Tîrgu Mureș, Romania

DOI: 10.2478/amma-2013-0067

Objective: To evaluate the anthropometric and biochemical status of children with nutritional deficiency.
Methods: We have conducted a prospective study on 226 children admitted in Pediatric Clinic I, divided into two groups: one group of 49 children with nutritional deficiency (body-mass-index < -2SD) and one control group (177 children). We have followed demographic data, anthropometric indices evaluated as standard deviations (weight, height, middle upper-arm circumference, tricipital skinfold), biochemical proteic status (Insulin-like Growth Factor 1 IGF-1, albumin, total proteins). We also followed parameters of general nutritional biochemistry.
Results: The mean age for underweight children was 5.8 years, lower than in the control group. The weight of the nutritional-deficient group was significantly lower than in the control group, unlike the height (p <0.001). We have also found significant differences in body-mass-index, middle upper-arm circumference and tricipital skinfold, all of them with low SDs in children with nutritional deficiency. Regarding the biochemical markers, we have found significantly higher values of transaminases (p <0.001) and lower IGF-1 (p = 0.02) and total proteins (p = 0.013) in nutritional-deficient group. Most IGF-1 values were in normal range in both groups, but with a higher percent of low values in nutritional deficient children (37.5% vs 14.2%, p = 0.0046). There were no significant differences in height, albumin, cholesterol, triglyceride and glucose levels between the two groups.
Conclusions: The anthropometric measurements are the most precise methods in evaluating the nutritional status. Among the studied biochemical markers, IGF-1, total proteins and transaminases are correlated with nutritional deficiencies.

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